Januvia (sitagliptin)

Main use

Active ingredient

Manufacturer

Type 2 diabetes

Sitagliptin phosphate monohydrate

Merck Sharpe & Dohme

How does it work?

Januvia tablets contain the active ingredient sitagliptin, which
is a type of medicine called a dipeptidyl peptidase 4 (DPP-4) inhibitor. It is
used to treat people with type 2 or non-insulin dependent diabetes
(NIDDM).

Sitagliptin works by increasing the amount of two incretin
hormones found in the body, called glucagon-like peptide-1 (GLP-1) and
glucose-dependent insulinotropic peptide (GIP). These hormones are normally
produced naturally by the body in response to food intake. Their function is to
help control blood sugar (glucose) levels.

GLP-1 and GIP have four main actions that help to control blood
glucose.

Firstly, they stimulate the pancreas to produce insulin in
response to increasing levels of glucose in the blood. (Insulin is the main
hormone responsible for controlling sugar levels in the blood. It causes cells
in the body to remove sugar from the blood.)

GLP-1 also reduces the production of glucagon. (Glucagon is a
hormone that normally increases glucose production by the liver.)

GLP-1 and GIP also reduce the rate at which food passes from the
stomach into the intestines, which slows down the absorption of glucose from
the gut into the bloodstream. Finally, they act on the brain to cause a feeling
of fullness that reduces further food intake.

GLP-1 and GIP are normally broken down by an enzyme in the body
called dipeptidyl peptidase 4. Sitaglipin works by binding to this enzyme and
preventing it from breaking down the GLP-1 and GIP. This increases the levels
of these hormones in the body and so increases their effect on controlling
blood sugar.

What is it used for?

Januvia can be used on its own to improve blood sugar control in people whose blood sugar is not controlled by changes to their diet and exercise alone and who can't take metformin.

Januvia is also used for people with type 2 diabetes whose blood
sugar is not sufficiently controlled by other antidiabetic medicines. It can be added to treatment with metformin, a sulphonylurea (for example gliclazide) or another type of antidiabetic
medicine known as a thiazolidinedione (for example pioglitazone or
rosiglitazone). It can also be used for people who are using insulin.

How do I take it?

Januvia is taken once daily. The tablets can be taken either with or without food.

Your tablet can be taken at any time of the day, but try to always take it at the same time of day, as this will help you to remember it.

If you forget to take a dose at your usual time you should take it as soon as you remember. However, if this means taking two doses in one day you should skip the missed dose and continue as normal. Don't take two doses in one day.

Warning!

It is important that you continue to follow the diet and exercise advice given to you by your doctor or nurse while you are using this medicine. This medicine only helps to control your blood sugar levels and should not be used as a substitute for eating healthily and taking regular exercise.

Hypoglycaemia (low
blood glucose) has been commonly reported when this medicine is used in
combination with sulphonylurea medicines, eg gliclazide or glibenclamide, or with insulin. Symptoms of hypoglycaemia usually occur suddenly and may include
cold sweats, cool pale skin, tremor, anxious feeling, unusual tiredness or
weakness, confusion, difficulty in concentration, excessive hunger, temporary
vision changes, headache, nausea and palpitations. You should talk to your
doctor about this and make sure you know what to do if you experience these
symptoms.

Your ability to concentrate or react may be reduced if you have
low blood sugar, and this can cause problems driving or operating machinery.
You should take precautions to avoid low blood sugar when driving – discuss
this with your doctor. This medicine may also uncommonly cause dizziness or
drowsiness. If affected you should take care driving or operating
machinery.

A few cases of inflammation of the pancreas (acute pancreatitis) have been reported in people taking sitagliptin and other medicines of this type. Symptoms of pancreatitis include unexplained, persistent, severe abdominal pain, sometimes spreading to the back. You should tell your doctor if you experience these symptoms while taking this medicine, so they can be investigated.

Use with caution in

Not to be used in

This medicine is not recommended for children and adolescents
under 18 years of age because it has not been studied in this age
group.

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have
previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop
using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or
breastfeeding. However, other medicines may be safely used in pregnancy or
breastfeeding providing the benefits to the mother outweigh the risks to the
unborn baby. Always inform your doctor if you are pregnant or planning a
pregnancy, before using any medicine.

The safety of this medicine for use during pregnancy has not
been established. It should not be used during pregnancy. Diabetes mellitus is
usually controlled using insulin during pregnancy, because this provides a more
stable control of blood sugar. If you get pregnant while taking this medicine,
or are planning a pregnancy, you should seek medical advice from your doctor.

It is not known if this medicine passes into breast milk. The
manufacturer states that it should not be used by breastfeeding mothers. Seek
medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual
people in different ways. The following are some of the side effects that are
known to be associated with this medicine. Just because a side effect is stated
here, it does not mean that all people using this medicine will experience that
or any side effect.

Disturbances of the gut such as nausea and vomiting, constipation, diarrhoea, abdominal pain.

Excess gas in the stomach and intestines
(flatulence).

Loss of appetite.

Swelling of feet or ankles (peripheral oedema).

Inflammation of the nose and throat, causing a blocked or runny
nose and sore throat (nasopharyngitis).

Upper respiratory tract infection.

Blocked nose.

Sore throat.

Low blood glucose levels (hypoglycaemia - when used with a sulphonylurea or insulin). See warning section above.

Inflammation of the pancreas (acute pancreatitis). See the warning section above.

The side effects listed above may not include all of the side
effects reported by the medicine's manufacturer.

For more information about any other possible risks associated
with this medicine, please read the information provided with the medicine or
consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines
you are already taking, including those bought without a prescription and
herbal medicines, before you start treatment with this medicine. Similarly,
check with your doctor or pharmacist before taking any new medicines while
taking this one, to make sure that the
combination is safe.

Sitagliptin may cause a small increase in the amount of digoxin
in the blood when both medicines are being taken together. If you are taking
digoxin, your doctor may want you to have regular blood tests to monitor the
amount of digoxin in your blood after you start treatment with this
medicine.

Medicines that increase blood sugar levels as a side effect may make this medicine less effective at controlling blood sugar. Medicines that can increase blood sugar levels include the following:

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.